24D-177 •
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two -year period shall not be considered a
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occuvancv
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
jermits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
understand the above.
(Home owner /resident's signature requestin ption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date 1 V �
Address of work
location J. `-' ` ti ti
• • . - 7
The Commonwealth of Massachusetts
Department of Industrictl Accidents •
t. E I4111 E 1 I Office of Investigations
600 Washington Street
Boston, MA 02111
- , www.mass.gov/dia .
•
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information - Please Print Legibly
Name (Business/Organization/Individual): —7 1\--' .kS ) L._
• Address: SD F--- ti) f■_) - .- - .
City/State/Zip: 1■1).-`-- ----\ K'') Phone.#:
Are you an employer? Check the appropriatehox: Type of project (required): i
1. D I am a employer with 4. 0 I am a general contractor and I
6. f.New construction (,...10:
- (full and/or part-time).* have hhed the sub-cor-tractors
2iV am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling
ship and have no e These sub-contractors have. .8. Ej Demolition
• working for me m any capacity. erAgoyees and have workers' •
9. 1:1Buildii* a
LNG workem' comp. insurance .
10.n Electrical repairs or adcrrtions
ed.] • - . 5. 0 We are a corporation and. its
officers have4xerc-ised their . 11.0 Phumbing repairs or a riditions •
3. IZ I am. a homeowner doing all work 1.
myself [No workers' comp. right of exemption per MGL
12.0 Roof repairs . •
insurance requirecLJ t c. 152, §1(4), and we have no •
13.0
employees. [No workers' Other
comp. insurance 1r-qui:real .
*Any applicant that cheelcs box ttl must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit inckating they are doing all work and then hire outside contractors must submit anew affidavit indicating such
Contractors that chn-Ir this box roust attached an additional sheet showing the name of the sub-contractors and state whetiser or not those entities have
employees If the sub-contractorshave employees, they must provide their workers comp. policy number.
lam an employer that is providing workers' compensation insurance for my employees. Below i.s the policy and job site
information.
.
Insurance Company Name: • ,
Policy # or Self-ins. Lic. #: Expiration Date:
. . .
Job Site Address: • • City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy nurnber and expiration date).
, .
Failure to secure coverage as required titter Sectioin`25A ofMGL c 152 can lead to the iinpOsitiaii of crimin41 penalties of a
fine up to S1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK-ORDER and a fine
of up to $250 00 a day against the violator. Be advised That a copy of this statement may be forwarded to the Office of
Enf eiationi "of theDIA for insurance Coveriee VficatiOn.
_ 116 herebylcerith under the painsand pen .. • ofperj , that the infonnationprovieled:abovelitni; frra rorrea _.
Signature: ----7 cA,.-x-)■g---■ , J . N - ' 1320; .--"-. I \■ \ . . ,
_
Phone #: A\ S 0:0 1 C) 6
. - Official use only Do not write in this area, to be completed by czty or toWn'okiciaL
• City or Town:
Permit/License #
Issuing Authority (circle one):
.-
:1. Board of Health 2. Building Department 3. City/Town Clerk 4. ElectricalInpector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #: '.. 0 . .
c:),.. \,..................../ •\.----" ‘.......... `..----& N ................. .. 1 \ , N.,,_____
) ._ 97.
RESIDENCE - .,
.,,
• V
Drain from garage Sewer line from residence to city
� � , L
connected to dry well ; �� � � � �, N� sewerage system.
� y ` � T- �D Strip drain
UP,t�
.\
3'-O' t
l
y
� l
II . ■ Drains 2% to Quick4 /S/ Chamber
v ' 0 ... - :
Q. s crushed i
tone dry well (36'x172"x14' ii-,
\.., b D
S 1.. 00
•
i
11 _ _ • _ _ .
S
/ — 4' -0' — t i rc -- _ >t\.)-3-\ ,
��'''"��
- ?— ,--,-
..,\ V4 .
< t_________----- t- - I 11 ':: 4-----
PARADISE CITY LANDSCAPE DESIGN AGNA - MARANTZ RESIDENCE `Drainage Detail
Margaret A. Leonard, MLA 50 Finn Street, Northampton, MA 01060 Scale 1/4" = 1-0"
P.O. Box 985, Northampton, MA 01061 April 9, 2011
tel. 413.478.7524
DECK ELEVATION
vc N t c u .D RA e1Q ro tok 1 N 'C
i3 C Co N no @_T( l e ) To b R y w L- -
f
IC.
Il i 1 ii t ncr Deddng
11 lei
....--- rim map,..
. _ - =
LI i -' , , . . . . .
o
.1141:-..., ......_ Ow
il
Drains 4.5% b Qukk4 !S! Chamber
r � K „ (3 4"x159"x12") on top of 1 1 414•
'i '-0" , f Concrete tootlng µ,, „�.�.�:�,�, , crushed stone dry well (38"x172'Sc't4”)
f
--1-4 TO J Water table
5'-0' - -
15'4'
. - 20
PARADISE CITY LANDSCAPE DESIGN AGNA- MARANTZ RESIDENCE Deck Elevation
Margaret A. Leonora MLA 50 Finn Street, Northampton, MA 01060 Scale 1/4" =1'-0"
P.O. Box 965, Northampton, MA 01061 April 9.2011
tel. 413.478.7524
,
NOTES:
Decking surface is cantilevered 18" from end beam with cross slope.
Steps are 6.5" risers, 12" tread depth. N( 2'? a , I6
x6
Main support beams supported by ledger board and 6" PT posts. ``
Post to joist connection using carriage bolts.
Deck surface
13' -0"
j Ledger board
Q (y
v_' >
1,A.: z c 4 Cantilevered
No
11'-6" decking
E �
x
'_O " --• - X18 "0►-
1 x
PARADISE CITY LANDSCAPE DESIGN AGNA- MARANTZ RESIDENCE Deck Detail
Margaret A. Leonard, MLA 50 Finn Street, Narthwnpton, MA 01080 Scale 3/8' =1'-0"
P.O. Box 985, Northampton, MA 01061 Aprl 9, 2011
tel. 413.478.7524 Rev. April 4, 2011
-NOTE -
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
103.25'
: \ W LL
(t
o I. #50 0 �
0 •
6
6 ,,
. L__
z
i B OK 1120, PAGE 267 Z
I: 103.25'
ALDRICH STREET
TO: FLORENCE SAVINGS BANK &
CONNECTICUT ATTORNEYS TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
-NOTE -
SURVEYOR ¢CR-Pa - �. -1-&\ THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY INSPECTION PLAT-
-MORTGAGE � �� of c,, NORTHAMPTON, N MASSACHUSETTS
RANED � PREPARED FOR
o IZER y GWEN AGNA & THOMAS M. MARANTZ
X3 5032 SCALE: 1 =20
" ' AUGUST 11, 2010
�' ;R° HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
•
SECTION 8 -- CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
8.:- 17ec1iste liTdirigi<itrierttinractar:c - R' F7 , Za Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10? WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ❑ No ❑
The current exemption for "homeowners" was extended to include Owner occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 1083.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -near period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the buildine permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [" Siding [0] Other [❑I]
Brief Description of Proposed
Work: \ L `7"- \ tEC-`G-
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓ No /
Attached Narrative Renovating unfinished basement Yes J No
Plans Attached Roll - Sheet
�� �"� � .v -. im �zc.. ./,r.. _ "�; ;��ha"� �sr(� � e �t � ��a. °'�-
641101 '�li fi r L1i11 +v 4� .1.I.1 Q` r. C'.Q 61 -tiii716116NinQ:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: ' 3" Number of Bathrooms
c. Is there a garage attached? `1
d. Proposed Square footage of new construction. (= t Sck TA- Dimensions L. )`' .3
e. Number of stories?
f. Method of heating? U 1- Fireplaces or Woodstoves 0 Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction wO
i. Is construction within 100 ft. of wetlands? Yes 7 No. Is construction within 100 yr. floodplain Yes /No
j. Depth of basement or cellar floor below finished grade 3 -''"( VA
k. Will building conform to the Building and Zoning regulations? ✓ Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION is • OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 ®- , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative t work authorized by this building permit application.
'"--."\---+,..\.,
Signature of Owner Date
I - 7'�v\-s J.J\ X , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner /Agent Date
•
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoiing
This column to be filled in by
Building Departmet)t
' Lot Size l T ), ‘,0 ix-- i
Frontage 1 lS , ?S 1 ti
Setbacks Front 124.x'( / ; Z i
Side LA .43-7 R:l 6` L:2,351 ; R:> �S •(.
Rear 1
Building Height 17-47:9 _. E . I
Bldg. Square Footage L}� � 1 % �- r i
Open Space Footage % ,
(Lot area minus bldg & paved l i G • 1 A j -w.
parking)
# of Parking Spaces l N } ,......,.---2
Fill:
I .
1
(volume & Location) ---
r 1
A. Has a Special Permit /Variance /Finding ver been issued for /on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:I I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book I 1 Page( a nd /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 12Y KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained
, Date Issued
C. Do any signs exist on the property? YES CY NO 0
I .
IF YES, describe size, type and location: 1 S i S.S.: 1::k.,Qv..� r ‘ !‹) ti (,�.ki_ -\tt-k
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location:
t
E. Will the construction activity disturb (clearing, grading, excav n, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
—
a: " ,
1,
City of Northampton I � ° �
APR 2 J ,�(��
Building Department
R
212 Main Street ffi
Room 100 � = �`�� ; g �E�E�` ��� �; A,
DEPT. OF BUILDING INSPECTIONg
NORTHAMPTON, MA01060 Northampton, MA 01060 ° �
phone 413- 587 -1240 Fax 413- 587 -1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TW O FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
.Map Lot : Unit
Zone Ov erlay District
Dc��.Tk "TC). � c (
ant St District' CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address:
ti s\ Telephone
Signature
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical Estima Total C of
3. Plumbing
Cons truction from (6)
Building (b) Permit Fee ost
4. Mechanical (HVAC)
5. Fire Protection _
6. Total = ( 5) Check Number 4‘o 9 - -Sty
This Section For Offi Use Only
Date
Building Permit Number: issued:
Signature:
Building Commissionedlnspector of Buildings; Date
Oar r � �
File # BP- 2011 -0889 t' �) ' 1v (c') 0-k*()
APPLICANT /CONTACT PERSON MARANTZ THOMAS M & GWEN AGNAt - It''-'
ADDRESS/PHONE 50 FINN ST NORTHAMPTON (413) 586 -0609 Q �'� Q
PROPERTY LOCATION 50 FINN ST S �'��/ 0 c
MAP 24D PARCEL 177 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
2.* 3 '" fi . �( ti J
PERMIT APPLICATION CHECKLIST c
ENCLOSED REQUIRED DATE` E
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out i � �
Fee Paid} 7
,p
Typeof Construction: CONSTRUCT 12 X 13 DECK i' r
New Construction G
Non Structural interior renovations
1
Addition to Existing
Accessory Structure
Building Plans Included:
Own er/ Statement or License
3 sets of Plans / Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON (ALL ( C) 1`1 CZ A 1?\)
INFO ATION PRESENTED:
Approved Additional permits required (see below)
( I")
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan ti 6 p E P {At! To
Major Project: Site Plan AND /OR Special Permit With Site Plan
QLO
ZONING BOARD PERMIT REQUIRED UNDER: §
L, E C A t.ESS A C
Finding Special Permit Variance*
CAtso Worry 5
Received & Recorded at Registry of Deeds Proof Enclosed GA (AA-V A f 1 0 A v ‘ I
Other Permits Required: 1
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission _ Permit DPW Storm Water Management
Demolition Delay
10
AIIP........_ ,..C/31/1
Signs re of Building 1 fficial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
50 FINN ST BP- 2011 -0889
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D - 177 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck BUILDING PERMIT
Permit # BP-2011-0889
Project # JS-2011-001447
Est. Cost: $3000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 5183.64 Owner: MARANTZ THOMAS M & GWEN AGNA
Zoning: URC(100)/ Applicant: MARANTZ THOMAS M & GWEN AGNA
AT: 50 FINN ST
Applicant Address: Phone: Insurance:
50 FINN ST (413) 586 -0609 ()
NORTHAMPTONMA01060 ISSUED ON: 5 /11/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 12 X 13 DECK
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 5/11/2011 0:00:00 $50.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner